A Patchy Prohibition: Product and Flavor Substitution After the Food and Drug Administration's Prioritized Enforcement Policy on Flavored E-cigarettes

INTRODUCTION

E-cigarettes have rapidly grown in use among U.S. adolescents; in response, the Food and Drug Administration (FDA) engaged in an "enforcement policy on banned e-cigarette flavors" ("enforcement action") for pod-based e-cigarettes in January 2020, which accounted for most U.S. e-cigarette sales. No literature has yet examined long-term changes in e-cigarette sales patterns changed in relation to the FDA enforcement action.

AIMS AND METHODS

We analyzed U.S. e-cigarette sales using Nielsen retail scanner data between March 2017 and December 2021, describing e-cigarette sales trends overall, by device type, and by flavor category. We also performed joinpoint regression analysis on the sales trends to detect significant changes in the rate of change of sales over time.

RESULTS

The FDA enforcement action was associated with a sharp initial decrease in prefilled pod dollar sales, followed by a steady increase from April 2020 through the end of 2021, growing beyond the previous maximum in August 2019. We also observed a dramatic change in the composition of flavors sold: A large decline in mint-flavored pod sales was offset by a similar increase in menthol-flavored sales. Simultaneously, disposable product sales increased nearly ten-fold from July 2019 to July 2020 before stabilizing, dominated by fruit-flavored products.

CONCLUSIONS

Our findings suggest rapid product substitution without a long-term decline in e-cigarette sales in association with the enforcement action, along with a growing dominance of youth-friendly flavors, contrasting against FDA policy goals. Our study revealed the weakness of the "patchy" enforcement action, raising concern about its unintended consequences as consumption simply shifted to other e-cigarette products.

IMPLICATIONS

This is the first detailed longitudinal study on e-cigarette sales trends in the United States following the FDA flavor enforcement action, with novel findings on flavor trends and their relation to policy events. We report sales overall, by product type, and by flavor category, and highlight several important trends following the action, such as the rise and persistence of disposable e-cigarettes increasingly and overwhelmingly dominated by youth-friendly flavors, and likely substitution of prefilled e-cigarette flavors without any long-term decline in sales. Our results highlight the weaknesses of "patchy" regulation and suggest the need for a more comprehensive approach to flavor regulation.

Individual differences in legal and illicit cannabis purchasing behaviour in British Columbia, Canada: Findings from a 2021 cross-sectional survey

BACKGROUND

Despite thousands of licensed cannabis retail stores operating across Canada, there remains a significant illicit cannabis market. Some cannabis users continue to buy cannabis from dealers, illicit stores, and/or illicit online retailers.

METHODS

Data are from the 2021 British Columbia Cannabis Use Survey. Respondents (n = 8473) were 19 years or older, lived in British Columbia at the time of the survey, and reported using cannabis in the past 12 months.

RESULTS

Buying cannabis from all types of illicit sources was more common among younger cannabis users, those who use cannabis more frequently and started using cannabis before the age of 17 (vs. 19 or older), and among those who co-use cannabis with other drugs. Specifically, buying cannabis from a dealer was more common among men, those with lower educational attainment, and those who seek the lowest prices when buying cannabis. In contrast, those using cannabis for medical (vs. non-medical) purposes were more likely to report getting cannabis from illicit retail stores, while buying cannabis from illicit websites was more common among people who use edible cannabis products.

CONCLUSION

Consistent with other studies, younger and more frequent cannabis users were more likely to report buying cannabis from illicit sources. However, these findings suggest there is significant heterogeneity among those who buy cannabis from different types of illicit sources, which should be carefully considered when developing policies and strategies aimed at encouraging consumers to transition to legal sources.

The Problem of Limited-Supply Agreements for Medicare Price Negotiation

This Viewpoint discusses how limited-supply agreements (introduction of generic products in reduced volumes) might thwart efforts to negotiate lower prices on prescription drugs in the US.

Five-Year Sales for Newly Marketed Prescription Drugs With and Without Initial Orphan Drug Act Designation

This study evaluates sales revenue earned in the first 5 years for newly marketed brand-name drugs with and without an initial orphan drug designation.

Hope-hype of green innovation, corporate governance index, and impact on firm financial performance: a comparative study of Southeast Asian countries

The current production and conception have impacted the environmental hazards. Green innovation (GI) is the ideal solution for sustainable production, consumption, and ecological conservation. The objective of the study is to compare comprehensive green innovation (green product, process, service, and organization) impact on firm financial performance in Malaysia and Indonesia, along with the first study to measure the moderation role of the corporate governance index. This study has addressed the gap by developing the green innovation and corporate governance index. Collected panel data from the top 188 publicly listed firms for 3 years and analyzed it using the general least square method. The empirical evidence demonstrates that the green innovation practice is better in Malaysia, and the outcome also shows that the significance level is higher in Indonesia. This study also provides empirical evidence that board composition has a positive moderation relationship betwixt GI and business performance in Malaysia but is insignificant in Indonesia. This comparative study provides new insights to the policymakers and practitioners of both countries to monitor and manage green innovation practices.

The impact of bank's engagement in shadow banking activities on bank's sustainability: Evidence from Chinese commercial banks

The economic and environmental consequences of bad banking practices have aroused much attention. In China, banks are at the center of shadow banking activities through which they avoid regulation and support environmentally unfriendly businesses such as fossil fuel companies and other high-pollution enterprises. In this paper, we study the impact of bank's engagement in shadow banking activities on its sustainability by using annual panel data of Chinese commercial banks. The result shows that bank's engagement in shadow banking activities has a negative impact on its sustainability and the negative impact of bank's engagement in shadow banking activities is more pronounced for city commercial banks and unlisted banks which are less regulated and lack corporate social responsibility (CSR). Furthermore, we explore the underlying mechanism of our findings and prove that bank's sustainability is impeded because it transforms high-risk loan into shadow banking activities which are less regulated. Finally, by using difference-in-difference (DiD) approach, we find that bank's sustainability improved after the financial regulation on shadow banking activities. Our research provides empirical evidence that the financial regulation on bad banking practices is beneficial for bank's sustainability.

Novel viruses highlight risks of Asia's wild animal trade

Sampling of game in China reveals many viral threats.

Evaluation of Statewide Restrictions on Flavored e-Cigarette Sales in the US From 2014 to 2020

IMPORTANCE

e-Cigarettes are the most commonly used tobacco product among US youths. Flavors are among the most cited reasons for use of e-cigarettes among youths, and therefore, some states have imposed restrictions on flavored e-cigarette sales. To our knowledge, no study has compared e-cigarette sales between states with statewide flavored e-cigarette restrictions and states without such restrictions while controlling for co-occurring events.

OBJECTIVE

To assess whether implementation of statewide restrictions on flavored e-cigarette sales in Massachusetts, New York, Rhode Island, and Washington was associated with a reduction in total e-cigarette unit sales from 2014 to 2020.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study with difference-in-differences analysis used e-cigarette retail sales data from Massachusetts, Rhode Island, and Washington, which implemented restrictions on flavored e-cigarette sales in October 2019; New York, which implemented these restrictions in May 2020; and 35 states without these restrictions (control states). Sales were summed into 4-week periods from August 24, 2014, to December 27, 2020, for a total of 2988 state-period observations.

MAIN OUTCOMES AND MEASURES

A difference-in-differences analysis was conducted to compare e-cigarette unit sales in the 4 states with flavor restrictions (before and after implementation) with those in the 35 control states. The model controlled for other population-based policies and emergent events (eg, the COVID-19 pandemic). Data on 4-week e-cigarette unit sales were sorted into 4 flavor categories (tobacco, menthol, mint, and other). Unit sales were standardized to reflect the most common package sizes for each product type.

RESULTS

Statewide restrictions on non-tobacco-flavored e-cigarette sales were associated with the following reductions in mean 4-week total e-cigarette sales in intervention states compared with control states from October 2019 to December 2020: 30.65% (95% CI, 24.08%-36.66%) in New York, 31.26% (95% CI, 11.94%-46.34%) in Rhode Island, and 25.01% (95% CI, 18.43%-31.05%) in Washington. In Massachusetts, the comprehensive sales prohibition of all e-cigarette products was associated with a 94.38% (95% CI, 93.37%-95.23%) reduction in 4-week sales compared with control states. Except in Massachusetts, where all sales of flavored e-cigarettes decreased, reductions were found only for non-tobacco-flavored e-cigarette sales in the other states with restrictions. Among control states, mean sales decreased by 28.4% from August 2019 to February 2020 but then increased by 49.9% from February through December 2020.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, statewide restrictions on the sale of flavored e-cigarettes in Massachusetts, New York, Rhode Island, and Washington were associated with a reduction in total e-cigarette sales. These findings suggest that not all e-cigarette users who purchased non-tobacco-flavored e-cigarettes switched to purchasing tobacco-flavored e-cigarettes after policy implementation.

The effect of different government subsidies on total-factor productivity: Evidence from private listed manufacturing enterprises in China

Private enterprises play an increasingly important role in China. They can improve the total-factor productivity (TFP) and help transform and upgrade industrial structures. This study uses data for private listed manufacturing companies from 2009 to 2017 to examine the effects of different types of subsidies on TFP. We also analyze the heterogeneity and specific mechanism of subsidy effects. We find that R&D subsidies and production subsidies positively affect private enterprises’ TFP. Moreover, R&D subsidies and production subsidies lagged by one period can also significantly increase private enterprises’ TFP. In terms of industry, R&D subsidies have more obvious effects on technology-intensive industries, while production subsidies have more significant effects on labor-intensive and capital-intensive industries. In terms of scale, R&D subsidies’ effects on the TFP of medium-sized enterprises are the largest, while production subsidies have the greatest effect on small enterprises’ TFP. Government subsidies increase private enterprises’ TFP through two mechanisms: improving technological innovation capability and alleviating financing constraints. Our results suggest that governments should formulate different subsidy policies according to industry and enterprise scale.

Pricing and assembly rate decisions for a prefabricated construction supply chain under subsidy policies

Prefabricated construction has attracted worldwide concern and promotion due to its environmental friendliness, high quality, and high efficiency. In China, the application of prefabricated construction still lags due to its high cost. To improve prefabricated construction development, the Chinese government and provinces have launched subsidy policies for different objects that offer subsidies to the assembler, the manufacturer, or consumers. Subsidy policies for different subsidy objects have different impacts on the manufacturer wholesale price and assembler retail price and assembly rate and make their decisions more complicated. Therefore, this study uses game theory and builds three models to analyze the effects of government subsidies on manufacturer pricing, assembler pricing, assembly rate decisions, and profit. We find that government subsidy policies can bring more profit to prefabricated construction enterprises, reduce their costs, and benefit the promotion of prefabricated construction. Through comparison and numerical analysis, we also find that when the government subsidizes enterprises more, it is better to subsidize the assembler, because it is good for all three parties. First, consumers can obtain a lower retail price. Second, enterprises can obtain more profits. Finally, for the government, this approach can increase the demand for prefabricated construction and increase the assembly rate, which is conducive to the promotion of prefabricated construction. When the government subsidizes customers more, it is better for the assembler and the manufacturer to subsidize customers, because they can obtain more profits. It is better for the government and customers to subsidize the assembler or the manufacture, because consumers can get the lower retail price. Although the assembly rate and enterprises’ profits are not optimal, they have also been improved. In addition, when the government directly subsidizes enterprises, the enterprises will actively cooperate with the subsidy policy and are more willing to adopt prefabricated construction. This approach will benefit the promotion of prefabricated construction.

The future of fish in Africa: Employment and investment opportunities

One of the most pressing challenges facing food systems in Africa is ensuring availability of a healthy and sustainable diet to 2.4 billion people by 2050. The continent has struggled with development challenges, particularly chronic food insecurity and pervasive poverty. In Africa's food systems, fish and other aquatic foods play a multifaceted role in generating income, and providing a critical source of essential micronutrients. To date, there are no estimates of investment and potential returns for domestic fish production in Africa. To contribute to policy debates about the future of fish in Africa, we applied the International Model for Policy Analysis of Agriculture Commodities and Trade (IMPACT) to explore two Pan-African scenarios for fish sector growth: a business-as-usual (BAU) scenario and a high-growth scenario for capture fisheries and aquaculture with accompanying strong gross domestic product growth (HIGH). Post-model analysis was used to estimate employment and aquaculture investment requirements for the sector in Africa. Africa's fish sector is estimated to support 20.7 million jobs in 2030, and 21.6 million by 2050 under the BAU. Approximately 2.6 people will be employed indirectly along fisheries and aquaculture value chains for every person directly employed in the fish production stage. Under the HIGH scenario, total employment in Africa's fish food system will reach 58.0 million jobs, representing 2.4% of total projected population in Africa by 2050. Aquaculture production value is estimated to achieve US$ 3.3 billion and US$ 20.4 billion per year under the BAU and HIGH scenarios by 2050, respectively. Farm-gate investment costs for the three key inputs (fish feeds, farm labor, and fish seed) to achieve the aquaculture volumes projected by 2050 are estimated at US$ 1.8 billion per year under the BAU and US$ 11.6 billion per year under the HIGH scenario. Sustained investments are critical to sustain capture fisheries and support aquaculture growth for food system transformation towards healthier diets.

The effects of the environmental protection tax law on heavily polluting firms in China

In 2016, China implemented an environmental protection tax (EPTL2016) to promote the transformation and upgrading of heavily polluting industries through tax leverage. Using panel data of China’s listed companies, this study assesses the treatment effects of the EPTL2016 on the transformation and upgrading of heavily polluting firms by incorporating the intermediary role of the financial market. The empirical findings show that the EPTL2016 significantly reduced the innovation investment and productivity of heavily polluting firms but had no significant effect on fixed-asset investment. Additionally, EPTL2016 reduced the supply of bank loans to heavily polluting firms and increased the value of growth options for private enterprises and the efficiency of the supply of long-term loans to heavily polluting firms. Although the environmental policy of EPTL2016 benefits the transformation and upgrading of heavily polluting industries in many aspects, it generally hinders the industrial upgrading because of the reduction of bank loans.

Wildlife must be protected from crime and trade for the sake of public and planetary health

COVID-19 most likely had its origins in wildlife, and hundreds of thousands of new viruses could spill over from wildlife to humans. We are struggling to combat climate change, and we are staring down the loss of a million species. It's time to change course.

Corporate political activity in the context of unhealthy food advertising restrictions across Transport for London: A qualitative case study

BACKGROUND

Diets with high proportions of foods high in fat, sugar, and/or salt (HFSS) contribute to malnutrition and rising rates of childhood obesity, with effects throughout the life course. Given compelling evidence on the detrimental impact HFSS advertising has on children's diets, the World Health Organization unequivocally supports the adoption of restrictions on HFSS marketing and advertising. In February 2019, the Greater London Authority introduced novel restrictions on HFSS advertising across Transport for London (TfL), one of the most valuable out-of-home advertising estates. In this study, we examined whether and how commercial actors attempted to influence the development of these advertising restrictions.

METHODS AND FINDINGS

Using requests under the Freedom of Information Act, we obtained industry responses to the London Food Strategy consultation, correspondence between officials and key industry actors, and information on meetings. We used an existing model of corporate political activity, the Policy Dystopia Model, to systematically analyse arguments and activities used to counter the policy. The majority of food and advertising industry consultation respondents opposed the proposed advertising restrictions, many promoting voluntary approaches instead. Industry actors who supported the policy were predominantly smaller businesses. To oppose the policy, industry respondents deployed a range of strategies. They exaggerated potential costs and underplayed potential benefits of the policy, for instance, warning of negative economic consequences and questioning the evidence underlying the proposal. Despite challenging the evidence for the policy, they offered little evidence in support of their own claims. Commercial actors had significant access to the policy process and officials through the consultation and numerous meetings, yet attempted to increase access, for example, in applying to join the London Child Obesity Taskforce and inviting its members to events. They also employed coalition management, engaging directly and through business associations to amplify their arguments. Some advertising industry actors also raised the potential of legal challenges. The key limitation of this study is that our data focused on industry-policymaker interactions; thus, our findings are unable to present a comprehensive picture of political activity.

CONCLUSIONS

In this study, we identified substantial opposition from food and advertising industry actors to the TfL advertising restrictions. We mapped arguments and activities used to oppose the policy, which might help other public authorities anticipate industry efforts to prevent similar restrictions in HFSS advertising. Given the potential consequences of commercial influence in these kinds of policy spaces, public bodies should consider how they engage with industry actors.

A Step Too Far? Whittington Hospital NHS Trust v XX [2020] UKSC 14

This comment piece explores the decision in Whittington Hospital NHS Trust v XX [2020] UKSC 14. It argues that despite notable shifts in public policy in respect of the acceptability of surrogacy as a means of family formation in the past twenty years, the Supreme Court has taken a step too far in deciding that foreign commercial surrogacy is as widely socially accepted. This impacts on the reasonableness of any claim for damages in negligence for the costs of commercial surrogacy. It is posited that the issue of whether damages for foreign commercial surrogacy are reasonable or not will be the key battleground in future negligence cases of this type.

Challenges to sovereign ambitions: forces of convergence and divergence within the global pharmaceutical sector and the UK's withdrawal from the European Union

This paper maps key regulatory, governance and legal challenges associated with the UK's withdrawal from the European Union (EU) in terms of convergent and divergent pressures within the global pharmaceutical sector. These include (i) convergent regulatory pressures associated with the European framework for pre-market licensing; (ii) convergent and divergent industry pressures with regard to drug discovery and manufacturing; and (iii) divergent and convergent market pressures associated with the supply, pricing and assessment of medicines. The UK's sovereign ambitions risk a loss of influence over the licensing and surveillance of pharmaceuticals under convergent regulatory and industry pressures to engage in unilateral participation in the European regime. Further, they also risk a loss of influence over processes for pricing and assessing the effectiveness of new treatment regimens under divergent market pressures from larger pharmaceutical markets outside the EU, notably the United States.

Support for Alcohol Policies in Marginalized Populations

AIM

Kingdon [(2014) Agendas, Alternatives, and Public Policies. Essex. United Kingdom: Pearson Education Limited] argues that windows of opportunity to pass policies emerge when problems, solutions and policy support co-occur. This study aims to identify a set of alcohol policies with the potential to reduce alcohol-related disparities given high levels of support from marginalized groups, such as racial/ethnic minorities and lower-income groups.

METHODS

This study used data from five US National Alcohol Surveys, which were based on household probability samples of adults in 1995 (n = 4243), 2000 (n = 5736), 2005 (n = 1445), 2010 (n = 4164) and 2015 (n = 4041). We used multiple logistic regression to determine the odds of policy support by racial/ethnic group and income level, considering price, place and marketing policies as well as individual-level interventions.

RESULTS

Overall a majority of Americans supported banning alcohol sales in corner stores (59.4%), banning alcohol advertisements on television (55.5%), and establishing universal health coverage for alcohol treatment (80.0%). Support was particularly high among Blacks, Hispanics/Latinos and lower-income persons. Multivariate models showed that compared with White people, foreign-born Hispanics/Latinos had the most robust levels of support, including raising alcohol taxes (aOR = 2.40, 95% CI: 2.00, 2.88, P < 0.0001), banning alcohol sales in corner stores (aOR = 2.85, 95% CI: 2.22, 3.65, P < 0.0001) and reducing retail sales hours (aOR = 2.91, 95% CI: 2.38, 3.55, P < 0.0001).

CONCLUSION

Of the policies examined, banning alcohol sales at corner stores is most likely to be in a "window of opportunity" for reducing alcohol-related disparities. By simultaneously reducing population-level consumption and harms from others' drinking, place-based policies have the potential to reduce harms experienced by marginalized groups.

Cannabis legalisation: should doctors be concerned?

A referendum on the Cannabis Legalisation and Control Bill was held in New Zealand. The Bill was meant to oversee government control over the production, supply and use of cannabis and reduce cannabis-related harm. Public health control was proposed over cannabis market by imposing licenses and cultivation, the quality and strength of marketed cannabis, and sale restrictions. Under this Bill, cannabis was only meant to be available to adults aged over 20 years through licenced stores. The potency of cannabis was to be limited. Cannabis use and was going to be permitted in private homes and specifically licensed premises. The Electoral Commission announced on 6 November 2020 that 50.7% of voters opposed the Bill and 48.4% supported it. Despite the outcome of the referendum, legalisation of cannabis may remain a live issue for many people, and doctors need to have an informed view about the impact of legalisation on mental health conditions. Experience from other countries shows that access to and potency of cannabis increased with legalisation. Despite the intent to prevent harm, cannabis legislation has been associated with adverse effects on mental health, emergency hospital presentations and crime. Public health strategies, including educating public about harm associated with cannabis, surveillance of potency and labelling, increasing minimal age for legal recreational cannabis use and bolstering treatment capacity for problematic cannabis use, including those with psychiatric disorders, should be funded by revenue generated from cannabis legislation.

Vape Shop Owners/Managers' Opinions About FDA Regulation of E-Cigarettes

INTRODUCTION

In the United States, prominent sources of vaping products are specialty vape shops, which are subject to Food and Drug Administration (FDA) regulation. This study interviewed vape shop owners/managers to assess: (1) reasons for entering into or engaging in vape shop retail; (2) personnel training, particularly with regard to FDA and state regulations; and (3) how existing regulations are perceived and the anticipated impact of future regulation.

AIMS AND METHODS

The current study involved phone-based semi-structured interviews of 45 vape shop owners/managers in six metropolitan statistical areas (Atlanta, Boston, Minneapolis, Oklahoma City, San Diego, and Seattle) during Summer 2018 as FDA regulations regarding minimum age verification, bans on product sampling, and health warnings (among others) were first being implemented.

RESULTS

Vape shop owners/managers reported: (1) entering the industry with positive intentions for their customers, (2) training their personnel to adhere to regulations and provide good customer service, and (3) significant concerns about the impact of FDA regulations. With regard to the latter, participants reported mistrust of the intentions of the FDA regulations, financial implications of the regulations (particularly for small businesses), difficulty understanding and interpreting the regulations, insufficient evidence to support the regulations, negative impact on customer service, negative impact on product offerings and product innovation/advancement, and negative implications of flavor bans and/or restrictions on sale of flavors.

CONCLUSIONS

These findings indicate the complexities in implementing tobacco regulations, particularly from the perspective of the vape shop industry. Current findings should inform future regulatory actions and efforts to assess compliance with regulations.

IMPLICATIONS

Current and impending FDA regulation of vaping products present a critical period for examining regulatory impact on the vape shop industry. Current results indicated that many vape shop owners/managers reporting positive intentions for engaging in the vaping product industry and in training vape shop personnel to adhere to regulations. However, the majority reported concerns about FDA regulation and other state/local regulations that could have negative implications for their industry. Particular concerns include difficulty understanding the regulations due to complexity, vagueness, and changes in language and/or interpretation over time. These issues have implications for compliance that must be addressed.

On using centrality to understand importance of entities in the Panama Papers

The Panama Papers comprise one of the most recent influential leaks containing detailed information on intermediary companies (such as law firms), offshore entities and company officers, and serve as a valuable source of insight into the operations of (approximately) 214,000 shell companies incorporated in tax havens around the globe over the past half century. Entities and relations in the papers can be used to construct a network that permits, in principle, a systematic and scientific study at scale using techniques developed in the computational social science and network science communities. In this paper, we propose such a study by attempting to quantify and profile the importance of entities. In particular, our research explores whether intermediaries are significantly more influential than offshore entities, and whether different centrality measures lead to varying, or even incompatible, conclusions. Some findings yield conclusions that resemble Simpson's paradox. We also explore the role that jurisdictions play in determining entity importance.

Spreading the sharing economy: Institutional conditions for the international diffusion of Uber, 2010-2017

This study examines the factors that facilitated the international diffusion of Uber, one of the fastest growing global companies in the sharing economy. We particularly focus on the legal and institutional conditions under which this ride-sharing platform could spread to customers online. Using a unique cross-national, longitudinal dataset, we employ event history models to investigate the effect of institutional environment on the diffusion of Uber. The results suggest that the establishment of the rule of law has a positive impact on the spread of Uber, even after controlling for economic and political characteristics. In addition, the overall quality of governmental regulations on markets is positively related to the diffusion of this ride-sharing platform. Our study contributes to the emerging literature on the sharing economy by identifying critical institutional factors that enable the transformation of business models worldwide.

Randomized Trial Testing an Online Responsible Vendor Training in Recreational Marijuana Stores in the United States

OBJECTIVE

An online training in responsible marijuana vendor (RMV) practices was evaluated for effects on compliance with ID checking regulations.

METHOD

A random sample of state-licensed recreational marijuana stores (n = 175) in Colorado and Washington State was selected in 2016-2017 and was enrolled in a randomized pretest-posttest controlled design. After baseline assessment, 75 stores were randomly assigned to a usual and customary training control group, stratified by state and region. The remaining stores (n = 100) were invited to use the RMV training. Stores were posttested at 3 and 9 months postrandomization. The primary outcome was refusal of sale measured with pseudo-underage patrons who attempted to enter stores and purchase cannabis without a state-approved ID.

RESULTS

There was no difference by treatment group in refusal of pseudo-underage patron buyers (baseline: 92.5% intervention vs. 94.7% control; 3-month posttest 94.8% vs. 97.5%; 9-month posttest 97.5% vs. 97.1%, p = .286 [one tailed, adjusted for covariates]). The use of training increased refusals at store entry (trained: 65.9% baseline 82.5%, 3 months 79.9%, 9 months; not trained: 82.6%, 83.1%, 84.5%, p = .020 [two tailed, adjusted for covariates]). This difference was especially evident in Washington State (trained: 40.3%, 65.1%, 60.4%; not trained: 57.9%, 68.5%, 72.3%) but not in Colorado (trained: 95.2%, 101.0%, 101.4; not trained: 95.7%, 98.6%, 99.2%, p = .033 [two tailed, adjusted for covariates]).

CONCLUSIONS

When used by store personnel, online RMV training increased refusal of buyers who appeared young and did not provide a state-approved ID. However, it did not improve refusal rates overall. Stores that had lower refusals at baseline and used the training may have benefited from it.

Association between county level cannabis dispensary counts and opioid related mortality rates in the United States: panel data study

OBJECTIVE

To examine county level associations between the prevalence of medical and recreational cannabis stores (referred to as dispensaries) and opioid related mortality rates.

DESIGN

Panel regression methods.

SETTING

812 counties in the United States in the 23 states that allowed legal forms of cannabis dispensaries to operate by the end of 2017.

PARTICIPANTS

The study used US mortality data from the Centers for Disease Control and Prevention combined with US census data and data from Weedmaps.com on storefront dispensary operations. Data were analyzed at the county level by using panel regression methods.

MAIN OUTCOME MEASURE

The main outcome measures were the log transformed, age adjusted mortality rates associated with all opioid types combined, and with subcategories of prescription opioids, heroin, and synthetic opioids other than methadone. The associations of medical dispensary and recreational dispensary counts with age adjusted mortality rates were also analyzed.

RESULTS

County level dispensary count (natural logarithm) is negatively related to the log transformed, age adjusted mortality rate associated with all opioid types (β=-0.17, 95% confidence interval -0.23 to -0.11). According to this estimate, an increase from one to two storefront dispensaries in a county is associated with an estimated 17% reduction in all opioid related mortality rates. Dispensary count has a particularly strong negative association with deaths caused by synthetic opioids other than methadone (β=-0.21, 95% confidence interval -0.27 to -0.14), with an estimated 21% reduction in mortality rates associated with an increase from one to two dispensaries. Similar associations were found for medical versus recreational storefront dispensary counts on synthetic (non-methadone) opioid related mortality rates.

CONCLUSIONS

Higher medical and recreational storefront dispensary counts are associated with reduced opioid related death rates, particularly deaths associated with synthetic opioids such as fentanyl. While the associations documented cannot be assumed to be causal, they suggest a potential association between increased prevalence of medical and recreational cannabis dispensaries and reduced opioid related mortality rates. This study highlights the importance of considering the complex supply side of related drug markets and how this shapes opioid use and misuse.

Illegal Wildlife Trade: A Gateway to Zoonotic Infectious Diseases

The illegal wildlife trade (IWT) is a criminal practice bringing several ecological and public health consequences, such as the spreading of zoonotic pathogens and/or the introduction of exotic species of animals into new geographical areas. Here, we discuss potential risks of IWT on the spreading and emergence of zoonotic pathogens.

Environmental regulation and financial performance of Chinese listed companies

OBJECTIVE

The answer to this article lies in: Does the financial activities of physical enterprises have an adverse impact on their main business? Is it conducive to the sustainable development of the national economy? However, when most scholars study the impact of environmental regulations on companies performance, they have not classified companies performance. This article will study the relationship between environmental regulations and performance levels based on the classification of companies performance, and then divide the nature of industry pollution, companies location and nature of property for in-depth research.

METHODS

First, this article uses a random effect variable-intercept model to measure companies financial performance and non-financial performance. Then, the variables are divided into two variable groups: light pollution and heavy pollution according to the nature of industry pollution. Next, the companies are divided into three variable groups: the eastern region, the central region, and the western region. Finally, the company is divided into two variable groups: state-owned and non-state-owned according to the nature of property.

CONCLUSIONS

The study found that: (1) Environmental regulations have inhibited companies financial activities. And the inhibitory effect of environmental regulations on the financial performance of enterprises is more obvious in the heavily polluting industries and enterprises in central and eastern regions. (2) Environmental regulations and companies non-financial performance are also negatively related, environmental regulations have also inhibited the non-financial performance of companies, this effect is more pronounced in heavily polluting industries and enterprises in western regions. (3) Income crowding effect brought by China's environmental regulations is greater than the income compensation effect brought by stimulating technological innovation.

States' Rights, Gun Violence Litigation, and Tort Immunity

The devastating toll of gun violence has given rise to hundreds of lawsuits seeking justice on behalf of victims and their families. A significant number of challenges against gun companies, however, are blocked by courts' broad reading of the Protection of Lawful Commerce in Arms Act (PLCAA) - a federal statute often interpreted to shield the gun industry from civil liability. This article reexamines PLCAA in light of the Supreme Court's recent federalism caselaw, which counsels courts to narrowly construe federal laws that could otherwise upset the balance of power between states and the federal government. Since PLCAA infringes on traditional areas of state authority, the Supreme Court's federalism jurisprudence requires lower courts to interpret PLCAA narrowly, to not bar states from imposing negligence, nuisance, product liability, or other common law liability on gun companies. Reading PLCAA in line with federalism principles would preserve states' traditional authority over their civil justice laws, and enable gun violence victims, and their families, to hold gun companies responsible for wrongdoing.

Gun Regulation Exceptionalism and Adolescent Violence: A Comparison to Tobacco

This article compares the landscape of tobacco regulations to the landscape of gun regulations, with a focus on regulations that target youth. This article argues that guns are significantly less regulated compared to tobacco, despite the frequency with which each product causes significant harm to both self and other.Many of the specific ways tobacco is regulated can be applied analogously to firearms while plausibly surviving potential Second Amendment challenges. This article compares the regulatory landscape of tobacco and firearms across six categories: (a) minimum age for purchase, (b) sale by unlicensed individuals, (c) taxation, (d) advertising, (e) graphic warning labels, and (f) zoning.At one time, tobacco was as central - or more so - to American culture as guns are today. However, many decades of public health advocacy led to historic tobacco regulations. Tobacco's regulatory history provides a valuable blueprint for gun regulation, despite Constitutional differences.

The Legal and Empirical Case for Firearm Purchaser Licensing

This article argues that state government actors concerned about gun violence prevention should prioritize enactment of robust firearm purchaser regimes at the state level. First, the article outlines the empirical evidence base for purchaser licensing. Then, the article describes how state governments can design this policy. Next, the article assesses the likelihood that purchaser licensing legislation will continue to be upheld by federal courts. Finally, the article addresses the implications of this policy, aimed at curbing gun deaths, for equally important racial justice priorities. Taken together, these various considerations indicate that purchaser licensing policies are among the most effective firearm-focused laws state governments can enact to reduce gun deaths within the existing federal legislative and legal frameworks.

The Right Time and Place: A New Approach for Prioritizing Alcohol Enforcement and Prevention Efforts by Combining the Prevalence and the Success Rate for Minors Purchasing Alcohol Themselves

OBJECTIVE

In the Netherlands, enforcement of the alcohol age limit is low and inconsistent because of limited resources. A solution is to optimize the efforts of enforcement officers by prioritizing ways in which they regulate commercial alcohol availability. This could increase compliance by sellers, curbing commercial availability. The objective of this study is to present the development of a commercial alcohol availability estimate (CAAE) for all vendor types selling alcohol and to propose a priority ranking.

METHOD

A multi-method design was used, combining data (collected in 2015) from national studies reporting behavior of minors purchasing alcohol themselves and the success rate (noncompliance) of alcohol vendors (interviewing 510 minors by telephone and conducting 1,373 purchase attempts of alcohol by minors, respectively). Descriptive data and the development of the CAAE are presented.

RESULTS

Compared with other vendor types (e.g., sports bars or supermarkets), bars/cafes/discos scored highest on the CAAE, indicating that 7.7% of 16- to 17-year-olds in the survey reported successfully purchasing their own alcohol at this vendor type.

CONCLUSIONS

To control commercial alcohol availability efficiently for minors in the Netherlands, our estimates suggest that enforcement and prevention efforts should prioritize bars/cafes/discos. However, local authorities should also consider local circumstances and maintain a base amount of attention for all vendor types. Ultimately, the CAAE has the potential to improve enforcer capacity and efficiency in policing commercial alcohol regulation, and prevention workers could align their interventions or campaigns to high-ranked vendor types.

Risks of emergency use authorizations for medical products during outbreak situations: a COVID-19 case study

BACKGROUND

The world is facing an unprecedented outbreak affecting all aspects of human lives which is caused by the COVID-19 pandemic. Due to the virus novelty, healthcare systems are challenged by a high rate of patients and the shortage of medical products. To address an increased need for essential medical products, national authorities, worldwide, made various legislative concessions. This has led to essential medical products being produced by automotive, textile and other companies from various industries and approved under the emergency use authorizations or legal concessions of national regulatory bodies. This paper presents a narrative commentary of the available documentation on emergency use authorizations and legal concessions for medical products during COVID-19 pandemic.

METHODOLOGY

The basis for narrative commentary includes scientific articles published in Web of Science, Scopus, PubMed and Embase databases, official publications of international organizations: Food and Drug Agency (FDA), World Health Organisation (WHO), World Bank and United Nations (UN), and national regulatory agency reports in native languages (English, German, Bosnian, and Croatian) published from November 1, 2019 to May 1, 2020. This paper focuses on three types of essential medical products: mechanical ventilators, personal protective equipment (PPE) and diagnostic tests. Evidence-informed commentary of available data and potential identified risks of emergency use authorizations and legal concessions is presented.

DISCUSSION

It is recognized that now more than ever, raising global awareness and knowledge about the importance of respecting the essential requirements is needed to guarantee the appropriate quality, performance and safety of medical products, especially during outbreak situation, such as the COVID-19 pandemic. Emergency use authorizations for production, import and approval of medical products should be strictly specified and clearly targeted from case to case and should not be general or universal for all medical products, because all of them are associated with different risk level.

CONCLUSION

Presented considerations and experiences should be taken as a guide for all possible future outbreak situations to prevent improvised reactions of national regulatory bodies.

Cannabis knowledge and implications for health: Considerations regarding the legalization of non-medical cannabis

Cannabis contains over a hundred of different cannabinoids, of which Δ⁹-tetrahydrocannabinol (THC) and cannabidiol (CBD) are the most well studied. The use of high-potency cannabis, containing high concentrations of THC and low concentrations of CBD, has been linked to adverse health outcomes, particularly for adolescents and young adults. Recently, an increase in cannabis potency has been observed in jurisdictions that legalized the sale of cannabis for non-medical purposes. Moreover, an increase of cannabis use and cannabis-related emergency treatment have also been observed in these jurisdictions. At the same time, risk perception regarding cannabis use has decreased in these populations. Trivializing language and an increased appearance of commercial cannabis in the public space may lead to a generalized underestimation of the risks of cannabis use. New regulation models principally focus on the creation of a legal cannabis market economy, the diversion of profits from illegal markets, and the reduction of costs associated with prohibition. However, an approach that specifically focuses on the rights to the health and safety of the individual should be considered in order to reduce the risks associated with cannabis legalization. Such an approach should promote and protect individual and social health and safety, establish a strict quality control of legal cannabis products regulated according to THC and CBD content, and eliminate all sorts of incentives to use, thus providing a more consistent, sustainable, and ethical framework for the legalization of non-medical cannabis use.